Provider Demographics
NPI:1922511054
Name:GROGAN-HANFORD, ANNE LOUISE (AGPCNP-BC, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:GROGAN-HANFORD
Suffix:
Gender:F
Credentials:AGPCNP-BC, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 QUAIL VLY W
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1554
Mailing Address - Country:US
Mailing Address - Phone:803-807-9197
Mailing Address - Fax:
Practice Address - Street 1:1317 QUAIL VLY W
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1554
Practice Address - Country:US
Practice Address - Phone:803-807-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4337363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology